共查询到20条相似文献，搜索用时 31 毫秒
1.
Amit Akirov Hiba Masri-Iraqi Alaa Atamna Ilan Shimon 《The American journal of medicine》2017,130(12):1465.e11-1465.e19
Background
The aim of this study was to investigate the association of albumin levels on admission and change in levels during hospitalization with hospitalization outcomes.Methods
Historical prospective data of patients hospitalized between 2011 and 2013 were collected. Levels of albumin were classified as marked hypoalbuminemia (<2.5 mg/dL), mild hypoalbuminemia (2.5-3.5 mg/dL), normal albumin (3.5-4.5 mg/dL), and hyperalbuminemia (>4.5 mg/dL). Main outcomes were length of hospitalization, in-hospital mortality, and long-term mortality.Results
The cohort included 30,732 patients (mean age 67 ± 18 years, 51% male). Most patients had normal albumin levels on admission (n = 20,124, 65%), 29% of patients had hypoalbuminemia, mostly mild (n = 7,334, 24%), and 5% of patients had marked hypoalbuminemia (n = 1436). Hyperalbuminemia on admission was evident in 6% of the patients (n = 1838). Follow-up (median ± standard deviation) was 1675 ± 325 days. Compared with in-hospital mortality with normal albumin on admission (2%), mortality was higher with mild (12%) and marked hypoalbuminemia (34%) and lower with hyperalbuminemia (0.3%). Mortality rate at the end of follow-up was 29% with normal albumin levels, 67% and 83% with mild and marked hypoalbuminemia, respectively. Patients with hyperalbuminemia on admission and before discharge have the best short- and long-term survival. This pattern was similar when analyzed separately in different age groups. In patients with hypoalbuminemia on admission, normalization of albumin levels before discharge was associated with better short- and long-term survival, compared with patients with hypoalbuminemia before discharge.Conclusions
Low albumin levels on admission are associated with increased short- and long-term mortality. Normalization of albumin levels before discharge was associated with lower mortality risk, compared with hypoalbuminemia before discharge. 相似文献2.
Maya Fayfman Georgia Davis Elizabeth W. Duggan Maria Urrutia David Chachkhiani Joanna Schindler Francisco J. Pasquel Rodolfo J. Galindo Priyathama Vellanki David Reyes-Umpierrez Heqiong Wang Guillermo E. Umpierrez 《Journal of diabetes and its complications》2018,32(12):1091-1096
Aim
We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery.Methods
This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n?=?44) or placebo (n?=?36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140?mg/dL and >180?mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications.Results
BG >140?mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p?=?0.93). BG >180?mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p?=?0.36. Both treatment groups had resulted in similar postoperative BG (148.9?±?29.4?mg/dL vs. 146.9?±?35.2?mg/dL, p?=?0.73). There were no differences in length-of-stay (4 vs. 3?days, p?=?0.84), ICU transfer (3% vs. 5%, p?=?1.00), hypoglycemia <70?mg/dL (6% vs. 11%, p?=?0.45), and complications (14% vs. 18%, p?=?0.76).Conclusion
Preoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery. 相似文献3.
Henry N. Ginsberg Daniel J. Rader Frederick J. Raal John R. Guyton Marie T. Baccara-Dinet Christelle Lorenzato Robert Pordy Erik Stroes 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2016,30(5):473-483
Purpose
Even with statins and other lipid-lowering therapy (LLT), many patients with heterozygous familial hypercholesterolemia (heFH) continue to have elevated low-density lipoprotein cholesterol (LDL-C) levels. ODYSSEY HIGH FH (NCT01617655) assessed the efficacy and safety of alirocumab, a proprotein convertase subtilisin/kexin type 9 monoclonal antibody, versus placebo in patients with heFH and LDL-C ≥ 160 mg/dl despite maximally tolerated statin ± other LLT.Methods
Patients were randomized to subcutaneous alirocumab 150 mg or placebo every 2 weeks (Q2W) for 78 weeks. The primary endpoint was percent change in LDL-C from baseline to week 24.Results
Mean baseline LDL-C levels were 196.3 mg/dl in the alirocumab (n = 71) and 201.0 mg/dl in the placebo groups (n = 35). Significant mean (standard error [SE]) reductions in LDL-C from baseline to week 24 were observed with alirocumab (?45.7 [3.5] %) versus placebo (?6.6 [4.9] %), a difference of ?39.1 (6.0) % (P < 0.0001). Absolute mean (SE) LDL-C levels were reduced from baseline by 90.8 (6.7) mg/dl with alirocumab at week 24, with reductions maintained to week 78. Treatment-emergent adverse events were generally comparable between groups. Injection-site reactions were more frequent in the alirocumab group (8.3 %) versus placebo (5.7 %); most were mild in severity and did not result in study medication discontinuation.Conclusions
In patients with heFH and very high LDL-C baseline levels despite maximally tolerated statin ± other LLT, alirocumab 150 mg Q2W demonstrated significant reductions in LDL-C levels with 41 % of patients achieving predefined LDL-C goals. Alirocumab was generally well tolerated.4.
Kazunori Sakurai Yuko Kawai Masanori Yamazaki Mitsuhisa Komatsu 《Journal of diabetes and its complications》2018,32(12):1118-1123
Aims
Continuous glucose monitoring (CGM) is not available for all patients with type 2 diabetes (T2D) at risk of nocturnal hypoglycemia (NH). This study was performed to predict the lowest nocturnal blood glucose (LNBG) levels.Methods
An LNBG prediction formula was developed by multivariate analysis using the data including self-monitoring of blood glucose from a formula making (FM) group of 29 insulin-treated T2D patients with CGM. The validity of the formula was assessed by nonparametric regression analysis of actual and predicted values in a formula validation group consisting of 21 other insulin-treated patients. The clinical impact on prediction was evaluated using a Parkes error grid.Results
In the FM group with a median age of 64.0, the following formula was established: Predicted LNBG (mg/dL)?=?127.4–0.836?×?Age (y)?+?0.119?×?Self-monitored fasting blood glucose (mg/dL)?+?0.717?×?Basal insulin dose (U/day) (standard error of calibration 17.2?mg/dL). Based on the validation results, standard error of prediction was 31.0?mg/dL. All predicted values fell within zones A (no effect on clinical action) and B (little or no effect on clinical outcome) on the grid.Conclusions
LNBG could be predicted, and may be helpful for NH prevention. 相似文献5.
Background and aim
The aim of this study was to examine the association between the admission neutrophil-to-lymphocyte ratio (N/L ratio) with coronary heart disease (CHD), separately from acute coronary syndrome (ACS) and stable angina (SA). A further aim was to investigate the clinical value of the N/L ratio in predicting in-hospital CHD events and the long-term prognosis of patients with CHD.Patients and methods
In all, 942 patients were enrolled and classified into a CHD group (comprising an ACS group and an SA group) and a normal group. Laboratory data including regular blood test results were obtained at baseline. The relationship between the N/L ratio and CHD, ACS, Gensini score, and multivessel lesions was analyzed by logistic regression. Receiver operating characteristics (ROC) curve analysis was used to identify the value of the N/L ratio in the diagnosis of CHD, ACS, and the severity of CHD. We divided the patients into four groups according to the N/L ratio quartiles and compared the differences in major adverse cardiac events (MACEs) that occurred in hospital and in the 4.26?±?0.57-year follow-up out of hospital.Results
Patients with an elevated N/L ratio had a significantly increased risk of CHD [odds ratio (OR)?=?1.697, 95?% confidence interval (CI) = 1.483–1.942], and an elevated N/L ratio was closely related to a higher risk of ACS (OR?=?1.652, 95?% CI = 1.434–1.902). The admission N/L ratio (0.664; 95?% CI = 1.942–1.616) showed a greater ROC area than the WBC and LDL-C values. Patients with a higher N/L ratio in both the SA group and the ACS group had a higher incidence of in-hospital and out-of-hospital MACEs, including long-term mortality and occurrence of new-onset heart failure or re-occurrence of heart failure. An elevated N/L ratio on admission was also found to be a significant indicator of 4.26-year MACEs.Conclusion
The admission N/L ratio was significantly associated with CHD and may become a risk predictor in the prognosis of patients with CHD.6.
《Clinical cardiology》2017,40(12):1291-1296
Background
Data on treatment results of lipid‐lowering therapy (LLT) in familial hypercholesterolemia (FH) are limited, particularly in Asian patients.Hypothesis
We sought to evaluate the target achievement rate and associated variables in Korean patients with FH after maximal statin‐based LLT.Methods
We enrolled 146 patients with heterozygous FH, and 90 patients were finally analyzed. Patients were initially prescribed rosuvastatin 10 mg or atorvastatin 20 mg, and the regimen was adjusted to achieve the low‐density lipoprotein cholesterol (LDL‐C) target of 100 mg/dL. The primary evaluation point was the achievement rate of the LDL‐C targets at 12 months: LDL‐C < 100 mg/dL and ≥50% LDL‐C reduction. The associations between clinical variables and target achievement were also analyzed.Results
At 12 months, 58% of patients were receiving high‐intensity regimens, whereas 46% were receiving combination therapy. The mean pre‐ and post‐treatment LDL‐C levels were 229 and 118 mg/dL, respectively. Twenty‐eight percent of patients achieved LDL‐C < 100 mg/dL, and 47% achieved ≥50% LDL‐C reduction. Pretreatment LDL‐C and high‐intensity regimens indicated a negative tendency toward the attainment of LDL‐C < 100 mg/dL. Conversely, pretreatment LDL‐C and diabetes mellitus were positively associated with a higher rate of ≥50% LDL‐C reduction.Conclusions
The target achievement of LDL‐C < 100 mg/dL was low, and 50% LDL‐C reduction was moderately achieved in Korean patients with FH receiving maximal statin‐based LLT. Pretreatment LDL‐C levels and diabetes mellitus were associated with target achievement. Our results provide rare and informative data on FH treatment in Asian patients.7.
P. Deharo M. Pankert J. Quilici C. Grosdidier V. Verdier G. Bonnet P. Morange M.-C. Alessi J.-L. Bonnet T. Cuisset 《Annales de cardiologie et d'angeiologie》2014
Background
Statin therapy is a cornerstone therapy for secondary prevention after acute coronary syndrome (ACS). However, the use of these drugs can be limited by side effects, mainly muscular pain. Ezetimibe is a newer lipid-lowering agent, with fewer side effects.Aims
The present study was designed to compare a commercially available association of ezetimibe and simvastatin (E-S) to high dose Rosuvastatin on cholesterol and muscular enzyme levels and occurrence of muscular pain.Methods
All consecutive ACS statin-naïve patients with LDL cholesterol (LDL-C) > 100 mg/dL randomly received either high dose statin (Rosuvastatin 20 mg) or E-S 10/40-mg. All patients had one-month follow-up with biological testing and clinical examination. We compared the two groups on the biological efficiency and incidence of muscular pain.Results
One hundred and twenty-eight patients were randomized; 64 received E-S and 64 Rosuvastatin. In the two groups, the lowering of LDL-C level (Δ = 51%) at one month was significant (P < 0.01) without any difference in the rate of lowering on LDL-C or HDL-C suggesting that E-S is as effective as high dose Rosuvastatin (P = 0.77 and P = 0.99). The rate of patients reaching the objective of LDL-C < 100 mg/dL (45%) and LDL-C < 70 mg/dL (51%) was not different in the two clusters (P = 0.65). Incidence of muscular pain was 15% higher in patients treated with Rosuvastatin (P = 0.01) without any difference on CPK level (P = 0.6).Conclusion
Using an association of E-S in an effective alternative strategy to high dose Rosuvastatin with a lower incidence of muscular pain, which might impact adherence to medication after ACS. 相似文献8.
Elnaz Javanshir Samad Ghaffari Reza Hajizadeh Hanieh Sakha Sahar Ghodratizadeh Hadiseh Kavandi 《Journal of electrocardiology》2018,51(5):870-873
Background
Electrocardiogram (ECG) is the first available modality used in patients with chest pain and dyspnea in emergency rooms.We aimed to study differences between acute coronary syndrome (ACS) and acute pulmonary embolism (APE) in patients presented primarily with abnormal negative T waves on their admission Electrocardiogram.Methods
This research was a retrospective study in which 297 patients (97 patients with APE and 200 with ACS) were included. The patients were admitted to the emergency ward of a tertiary heart center between 2015 and 2017. In addition to the evaluation of distribution of negative T waves, the depth of the inverted precordial T waves was measured.Results
The mean age of patients was 62.0?±?11.4 in ACS group and 60.7?±?17.6 in APE group (P value?=?0.563). Total negative T in V3 and V4 in ACS and APE groups was 9.1?mm and 4.2?mm respectively (P value <0.001).Total magnitude of negative T in anterior leads divided by total magnitude of negative T in inferior leads for ACS and APE groups were 15.1?±?12.0 and 5.4?±?3.6 respectively (P value?=?0.001).ROC curves showed that total magnitude of negative T in V4 divided by negative T in V1 can be valuable. A cutoff point of 1.75 with sensitivity of 73.5% and specificity of 84.9% (95% CI 0.79–0.91 P?<?0.001) could differentiate APE patients from ACS patients.Conclusion
This study suggests that total magnitude of negative T in left precordial leads divided by right precordial leads can be valuable in differentiating APE from ACS. 相似文献9.
10.
Dylan L. Steen Amarachi A. Umez‐Eronini Jianping Guo Naseer Khan Christopher P. Cannon 《Clinical cardiology》2018,41(1):68-73
Background
For decades, fasting for 8 to 12 hours has been recommended for measurement of lipid profiles. The effect of fasting on low‐density lipoprotein cholesterol (LDL‐C) and triglycerides (TG) has been described in healthy cohorts and those with stable disease states. Recently, guidelines suggested that fasting may not be necessary due to its small effect on lipid measures. Little is known, however, regarding whether the impact of fasting is altered in the setting of an acute coronary syndrome (ACS).Hypothesis
We hypothesized that the post‐ACS period would minimally effect the impact of fasting status on lipid measurements.Methods
We evaluated the association of fasting on lipid and other biomarkers at the randomization visit, which occurred at a median of 7 days after the onset of an ACS, as well as during follow‐up, in a cohort of 4177 subjects from the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22 (PROVE IT–TIMI 22) trial.Results
Fasting samples were independently associated with a higher LDL‐C of 4.1 mg/dL and apolipoprotein‐B 100 of 2.6 mg/dL as well as a lower TG of 21.0 mg/dL and high‐sensitivity C‐reactive protein of 0.48 mg/dL. The relative difference was 3.8% for LDL‐C and ?11.3% for TG. Fasting did not change total cholesterol, high‐density lipoprotein cholesterol, apolipoprotein A‐I, lipoprotein(a), or apolipoprotein C‐III.Conclusions
Although fasting does impact lipid measurements, the effect on LDL‐C is small (about 4 mg/dL), both early after ACS and during follow‐up. These data provide support for recent guidelines that no longer advocate for fasting lipid samples, including in the setting of ACS.11.
Charat Thongprayoon Wisit Cheungpasitporn Wonngarm Kittanamongkolchai Andrew M. Harrison Kianoush Kashani 《The American journal of medicine》2017,130(5):545-554.e1
Objective
The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients.Methods
This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality.Results
Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients.Conclusions
Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients. 相似文献12.
Frederick J Raal Dirk J Blom Shanil Naidoo Peter Bramlage Philippe Brudi 《Cardiovascular journal of Africa》2013,24(8):330-338
Introduction and objectives
Cardiovascular disease (CVD) is the leading cause of mortality worldwide and increased levels of low-density lipoprotein cholesterol (LDL-C) are an important modifiable risk factor. Statins lower LDL-C levels and have been shown to reduce CVD risk. Despite the widespread availability of statins, many patients do not reach the lipid targets recommended by guidelines. We evaluated lipid goal attainment in statin-treated patients in South Africa and analysed variables contributing to poor goal attainment as part of the DYSlipidaemia International Study (DYSIS).Methods
This cross-sectional, observational study enrolled 1 029 consecutive South African patients consulting officebased physicians. Patients were at least 45 years old, had to be treated with a stable dose of statins for at least three months and had been fasting for 12 hours. We evaluated lipid goal attainment and examined variables associated with residual dyslipidaemia [abnormal levels of LDL-C, highdensity lipoprotein cholesterol (HDL-C) and/or triglycerides (TG)].Results
We found that 50.3% of the patients overall did not achieve target LDL-C levels and 73.5% of patients were at very high cardiovascular risk. In addition, 33.7% had low levels of HDL-C, while 45.3% had elevated TG levels despite statin therapy. Asian and mixed-ancestry patients but not black (vs Caucasian ethnicity), as well as obese individuals in South Africa were more likely to still have dyslipidaemia involving all three lipid fractions.Conclusions
We observed that many patients in South Africa experienced persistent dyslipidaemia despite statin treatment, supporting the concept that there is a need for more intensive statin therapy or the development of novel treatment strategies. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital for effectively controlling dyslipidaemia and reducing the burden of CVD. 相似文献13.
Background
Acute coronary syndrome (ACS) refers to a spectrum of symptoms compatible with acute myocardial ischemia. Plasma markers of inflammation have been recently identified as diagnostic aid and risk predictors. The present study, conducted in Slemani Cardiac Hospital (SCH), Sulaimaniyah, Iraq aimed to recognize some risk factors for ACS in Iraqi adults younger than 40.Methodology
This is a prospective case-control study of 100 patients with ACS vs. a control group of 100 healthy volunteers. The study began at 1st January 2014 and ended at 31st December 2016. All patients were subjected to full history taking, clinical examination including measurement of waist circumference and body mass index (BMI). Investigations included electrocardiography (ECG), echocardiography, full blood count, measurement of lipid profile and C-reactive protein (CRP). The patients were managed by percutaneous coronary intervention (PCI).Results
The mean age of the patients was 36?years (range 28–40). Eighty-five% of patients were male. The mean BMI (29?kg/m2) and waist circumference (98?cm) of the patients were higher than the controls (24?kg/m2 and 72?cm respectively). The leukocytes, lymphocytes and neutrophil counts as well as CRP in both groups were within the normal range. The most prevalent risk factor was obesity (n?=?86). Other risk factors were smoking (n?=?62), hypertension (n?=?26), diabetes mellitus (n?=?22) and positive family history of ACS (n?=?24). Most patients (n?=?83) had multi-vessel coronary artery disease (2–3 vessels).Conclusion
ACS in young adults is an increasing health problem. Obesity was found to be the most prevalent risk factor. 相似文献14.
Ballantyne CM Jones PH Kelly MT Setze CM Lele A Thakker KM Stolzenbach JC 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2011,25(1):59-67
Objective
The objective of this study was to evaluate the long-term efficacy of adding fenofibric acid to moderate-dose statin therapy in patients at goal for low-density lipoprotein cholesterol (LDL-C) but with persistent hypertriglyceridemia.Methods
This is a post hoc analysis of a subset of patients (N?=?92) with mixed dyslipidemia treated with moderate-dose statin (rosuvastatin 20 mg, simvastatin 40 mg, or atorvastatin 40 mg) for 12 weeks in three controlled trials who had achieved LDL-C <100 mg/dL but whose triglycerides remained >200 mg/dL, and had fenofibric acid 135 mg added to the moderate-dose statin in a 52-week open-label extension study. Lipid and apolipoprotein (Apo) values and the proportion of patients meeting individual and combined treatment targets with combination therapy were determined at scheduled visits during the 52-week study and compared with baseline (start of extension study).Results
Addition of fenofibric acid to moderate-dose statin for 52 weeks resulted in significant (P?P?=?0.007), and LDL-C?+?non–HDL-C?+?ApoB?+?HDL-C?+?triglycerides (25.6% vs 0.0%) than at baseline.Conclusions
The addition of fenofibric acid to moderate-dose statin in patients whose LDL-C was optimal but whose triglycerides remained >200 mg/dL led to additional improvements in non–HDL-C, ApoB, HDL-C, and triglycerides that resulted in greater proportions of patients attaining optimal levels of the individual parameters as well as simultaneously achieving optimal levels of these parameters and LDL-C.15.
Larisa Broglie Alfred Rademaker John Galvin Ayita Ray William T. Tse Reggie Duerst Jennifer Schneiderman Morris Kletzel Sonali Chaudhury 《Hematology/oncology and stem cell therapy》2018,11(3):169-174
Background
Acute graft versus host disease (aGVHD) affects approximately 30–60% of patients after allogeneic hematopoietic stem cell transplantation (HCT) and our ability to predict who develops this complication and their response to treatment is limited. Fecal calprotectin has recently gained popularity as an effective marker of GI inflammation in patients with Inflammatory Bowel Disease (IBD).Methods
Fecal calprotectin and albumin were evaluated as prognostic and predictive markers of aGVHD in 60 adult and pediatric HCT patients. Stool samples were sent for calprotectin quantification prior to starting conditioning, at day 14 post-HCT, at day 28 post-HCT, and at onset of aGVHD ±?2 days.Results
Fecal calprotectin did not differentiate patients with GI-GVHD and non-GI GVHD and did not vary based on severity. However, in patients with steroid-refractory GI aGVHD, significantly higher fecal calprotectin levels were noted. At onset of lower-GI symptoms, steroid refractory patients (n?=?3) had a mean fecal calprotectin level of 449?ug/g (range 116–1111?ug/g) and a mean albumin of 1.93?g/dL (range 1.6–2.3?g/dL) compared with a mean fecal calprotectin of 24?ug/g (range 16–31?ug/g) and a mean albumin of 3.3?g/dL (range 2.3–3.9?g/dL) in steroid responsive patients (n?=?9) (fecal calprotectin p?=?0.032, albumin p?=?0.027).Conclusion
Patients with steroid-refractory GI aGVHD had higher fecal calprotectin levels and lower albumin levels than patients with steroid-responsive disease. We recommend further studies to evaluate non-invasive tests with fecal calprotectin in combination with albumin in predicting steroid refractory disease at onset of symptoms to potentially identify patients that may benefit from upfront escalation in GVHD treatment. 相似文献16.
S. Béliard V. Carreau A. Carrié P. Giral E. Duchêne M. Farnier J. Ferrières A. Fredenrich M. Krempf G. Luc P. Moulin E. Bruckert 《Atherosclerosis》2014
Background
Heterozygous Familial Hypercholesterolemia (heFH) is an autosomal disease that affects about 1/500 people. It is characterized by markedly elevated plasma LDL-cholesterol (C) levels and an increased risk of cardiovascular disease (CVD). The aim of this study was to measure changes in LDL-C levels in heFH patients over two decades, and to evaluate if patients achieved LDL-C targets.Methods
Data from 1669 heFH patients in five academic French centers were recorded between 1988 and 2011.Results
The mean LDL-C concentrations under medical care improved between 1988 and 2011 (245 mg/dL before 1995, 164 mg/dL after 2009; p < 0.0001). However, mean LDL-C level and the number of patients treated with statins (79.3%) have not improved since 2005. In patients registered and treated after 2005 (n = 616), only 10.4% reached target LDL-C levels of <100 mg/dL. Indeed, 29.4% (n = 181) were treated with a maximal therapy (statins with a potency of >45% LDL-C reduction plus at least another lipid-lowering agent). Despite maximal treatment, only 18.8% of these heFH patients (n = 34/181) reached target LDL-C levels of <100 mg/dL. In addition, 75.3% of patients with CVD did not reach the LDL-C of <100 mg/dL.Conclusion
This study demonstrates that after significant improvement over the past two decades, the mean LDL-C levels in heFH French patients has remained stable since 2005. We also show that most heFH patients are not achieving their recommended LDL-C goals: this highlights the need for improved treatment and for new therapeutics in this population. 相似文献17.
Noha Hassanin Hanboly Yasser Mohamed Baghdady Reda Huissen Diab Sameeh Ramadan Lawend Ahmed Abdelazim Kenawy 《Journal of the Saudi Heart Association》2018,30(3):211-221
Background
Limited information is available regarding the relationship between coronary vessel dominance and outcome after ST-segment elevation myocardial infarction (STEMI).Objectives
The study was designed to evaluate the prognostic value of coronary arterial dominance after primary percutaneous coronary intervention (PCI) during hospital stay and at 3?months follow-up regarding cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke.Patients and methods
The study population consisted of 300 consecutive patients (mean age, 57.35?±?13.41?years; 91% men) with STEMI who were admitted to Dallah Hospital (Riyadh, Saudi Arabia) from January 2015 to December 2016. These patients underwent successful primary PCI with thrombolysis in myocardial infarction (TIMI) III flow. They were divided into three groups according to angiographic coronary dominance: 227 (75.7%) in the right coronary dominant group, 40 (13.3%) in the left coronary dominant group, and 33 (11%) in the balanced coronary dominant group. They were evaluated with two- (2D) and three-dimensional (3D) echocardiography within 48 hours of admission and at 3?months follow-up after STEMI.Results
Right dominance was present in 75.6%, left dominance in 13.3%, and balanced dominance was present in 11% of patients. The main finding of this study was that a left dominant system was associated with increased risk of cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke shortly after primary PCI, during hospital stay, and at 3?months follow-up after STEMI. Moreover, a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system.Conclusion
In patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3?months follow-up compared to right and balanced coronary artery dominance. 相似文献18.
Background
Coronary artery disease is one of the main causes of death in diabetes mellitus (DM). Egypt was listed among the world top 10 countries regarding the number of diabetic patients by the International Diabetes Federation (IDF).Aim of work
Assessment of the extent of coronary atherosclerotic disease and lesion tissue characterization among diabetic compared to non-diabetic Egyptian patients.Methodology
IVUS studies of 272 coronary lesions in 116 patients presented with unstable angina were examined. The patients were divided into two groups: diabetic group (50 patients with 117 lesions) and non-diabetic group (66 patients with 155 lesions).Results
As compared to the non-diabetic group, the diabetic patients were more dyslipidemic (84% vs 39.4%, p?=?0.001) with higher total cholesterol level (194.6?±?35.3 vs 174.4?±?28.5?mg/dl, p?=?0.001) and higher LDL-C (145.3?±?27.1 vs 123.2?±?31.4, p?=?0.001). Regarding lesions characteristics, the diabetic group had longer lesions (19.4?±?7.4 vs 16.3?±?7.9?mm, p?=?0.002) with higher plaque burden (60.8?±?15.3 vs 54.8?±?14.0, p 0.002) and more area stenosis percentage (60.8?±?15.6 vs 55.6?±?14.1, p?=?0.008). Structurally, the diabetic group lesions had more lipid content (19.8?±?8.8 vs 16.8?±?8.7, p?=?0.008) and more necrotic core (17.6?±?7.4 vs 14.7?±?4.8, p?=?0.008) but less calcification (6.9?±?3.6 vs 11.8?±?6.3, p?=?0.001). The RI was negative in both groups, 0.95?±?0.13 in the diabetic group vs 0.98?±?0.19 in non-diabetic group (p?=?0.5). Within the diabetic group lesions, the dyslipidaemic subgroup had more lipid content (23.?±?5.2 vs 14.6?±?8.6, p?=?0.01) but less fibrotic component (48.6?±?4.7 vs 59.1?±?13.6%, p?=?0.01) and less calcification (10.9?±?6.8% vs 14.07?±?3.8%, p?=?0.02) as compared to the nondyslipidaemic subgroup.Conclusions
Diabetic patients with coronary atherosclerosis in Egypt have longer lesions with higher plaque burden and more percent area stenosis with negative remodeling index. The diabetic lesions had more lipid content and more necrotic core but less calcification. 相似文献19.
Matthew J. Crowley Stephanie D. Melnyk Jared L. Ostroff Sonja K. Fredrickson Amy S. Jeffreys Cynthia J. Coffman David Edelman 《The American journal of medicine》2014
Background
Group medical clinics may improve diabetes and hypertension control, but data about dyslipidemia are limited. We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension.Methods
Prespecified secondary analysis of 239 veterans randomized to group medical clinics or usual care. Lipids were assessed at study baseline, midpoint, and end. We used linear mixed models to compare lipid levels between arms and generalized estimating equation models to compare low-density lipoprotein cholesterol (LDL-C) goal attainment. An additional post hoc analysis examined intensification of cholesterol-lowering medications in both arms.Results
At baseline, mean total cholesterol was 169.7 mg/dL (SD 47.8), LDL-C 98.2 mg/dL (SD 41.7), and high-density lipoprotein cholesterol (HDL-C) 39.3 mg/dL (SD 13.0). Median baseline triglycerides were 131 mg/dL (interquartile range 122). By study end, mean total cholesterol and LDL-C in group medical clinics were 14.2 mg/dL (P = .01) and 9.2 mg/dL (P = .02) lower than usual care, respectively; 76% of group medical clinic patients met goals for LDL-C, versus 61% of usual care patients (P = .02). Triglycerides and HDL-C remained similar between study arms. Treatment intensification occurred in 52% of group medical clinic patients, versus 37% of usual care patients between study baseline and end (P = .04). The mean statin dose was higher in group medical clinic patients at study midpoint and end.Conclusions
Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension. This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care. 相似文献20.
Hibi K Kimura T Kimura K Morimoto T Hiro T Miyauchi K Nakagawa Y Yamagishi M Ozaki Y Saito S Yamaguchi T Daida H Matsuzaki M;JAPAN-ACS Investigators 《Atherosclerosis》2011,219(2):743-749